Deck 8: Pathophysiology

Question 1

Which of the following is required for normal perfusion to occur?

A) Airway patency, proper amounts of oxygen, adequate glucose levels
B) Adequate breathing, sufficient red blood cells, good heart function
C) Intact breathing, ample red blood cells, body temperature of 98.6°F
D) Patent airway, sufficient breathing, high amounts of glucose, good heart function

Answer 1

B

Question 2

For a patient breathing in room air, the EMT would estimate the FiO₂ to be:

A) 0.15.
B) 0.21.
C) 0.55.
D) 1.00.

Answer 2

B

Question 3

The patient in anaerobic metabolism is deficient of:

A) glucose (sugar).
B) protein.
C) lactic acid.
D) oxygen.

Answer 3

D

Question 4

For cells to undergo the process of aerobic metabolism, the cells require:

A) water and oxygen.
B) sugar (glucose) and protein.
C) adenosine triphosphate (ATP) and lactic acid.
D) oxygen and glucose.

Question 5

A patient with a low blood sugar is unresponsive with snoring respirations. His breathing is labored and his pulse is rapid and weak. Examination of the skin reveals it to be cool and diaphoretic. Your partner informs you of the following vital signs: pulse 120, respirations 18, blood pressure 132/60, and SpO₂ at 84% on room air. Which one of the following actions would you perform first?

A) Administer oral glucose.
B) Perform a head-tilt chin-lift.
C) Provide high-concentration oxygen.
D) Start positive pressure ventilation.

Question 6

A young patient is experiencing epiglottitis (swelling of the epiglottis). He is working hard to breathe, has stridorous respirations, and is extremely hypoxic. His skin is cyanotic and pulse rapid but strong. Which of the following is most likely causing the poor delivery of oxygen to the cells?

A) Partial occlusion of the airway
B) Impaired transfer of O₂ between the lungs and blood
C) Poor function of the heart as a pump
D) Elevation of the heart rate

Question 7

The EMT would document an FDO₂ level when she is:

A) assisting breathing with a bag-valve-mask device.
B) inserting a nasopharyngeal airway.
C) providing oxygen at greater than 10 liters per minute.
D) using a nonrebreather face mask with high-concentration O₂.

Question 8

A patient who is hypoxic has a pulmonary disease that involves low lung compliance. As such, you realize:

A) the lung tissue is easily inflated and can be damaged.
B) oxygen and carbon dioxide cannot be exchanged across the alveolar wall.
C) the patient has tremendous swelling to the small airways.
D) ventilation with a bag-valve mask will require more effort.

Question 9

When the cells undergo normal metabolism, which one of the following occurs?

A) Heat, carbon dioxide, and water are produced.
B) Lactic acid is produced and excreted by the kidneys.
C) Decreased amounts of oxygen are required.
D) Adenosine triphosphate (ATP) is produced and excreted by the lungs.

Question 10

The EMT is administering oxygen at 95% through a nonrebreathing face mask. He would document this as a FiO₂ of:

A) 0.21.
B) 0.50.
C) 0.95.
D) 1.00.

Question 11

A patient who has lost 1 liter of blood is conscious with a patent airway, but his extremities are pale and cold to the touch. Vital signs are pulse 130, respirations are 22 and adequate, blood pressure is 74/56, and SpO₂ is 95% on room air. Which one of the following is most needed by this patient to increase perfusion to the cells?

A) Increased blood pressure by giving IV fluids
B) Administration of oxygen
C) Increased number of red blood cells and plasma volume
D) Keeping the patient warm

Question 12

Perfusion is best described as:

A) availability of oxygen to the lungs for placement into the blood.
B) an adequate amount of white blood cells to carry oxygen to the cells.
C) delivery of essential products and nutrients to the cell for its use.
D) exchange of oxygen and carbon dioxide between the lungs and blood.

Question 13

A patient is hemorrhaging internally within his colon, therein impairing perfusion to the cells of his body. Aside from the bleeding, the patient has no other problems. In this scenario, the problem impairing adequate perfusion would be:

A) decreased blood volume.
B) inability to get oxygen to the blood.
C) poor myocardial pump function.
D) inadequate ventilation to eliminate carbon dioxide.

Question 14

Failure of the sodium potassium pump can result in:

A) accumulation of acidic wastes.
B) excess amounts of sodium outside of the cell.
C) large amounts of potassium inside the cell.
D) cellular damage, swelling, and rupture.

Question 15

A patient's brain cells are undergoing anaerobic metabolism. As a result, those cells:

A) are becoming dysfunctional in a highly acidic environment.
B) have too much adenosine triphosphate (ATP) to function properly.
C) are producing elevated quantities of carbon dioxide (CO₂).
D) cannot make any energy in the form of ATP.

Question 16

The EMT would best recognize normal cellular metabolism as:

A) oxygenated.
B) aerobic.
C) glycolytic.
D) anaerobic.

Question 17

A patient's lungs are full of fluid and cannot transfer oxygen to the blood. As a result, she is in anaerobic metabolism. She has a decreased level of consciousness with a patent upper airway and inadequate respirations. Her pulse is rapid and weak. Which one of the following prehospital treatments would best address this situation?

A) High-concentration oxygen through a nonrebreather face mask
B) Intravenous (IV) fluids administered by paramedics
C) Positive pressure ventilation with supplemental oxygen
D) Insertion of a nasal airway and oxygen through a nasal cannula

Question 18

A 20-year-old female has called 911 for chest pain. On scene you find that she has shallow breathing with an SpO₂ reading of 91% on room air. She states she was in a car crash yesterday and diagnosed in the hospital with broken ribs. She says that her pain is right where the ribs are broken and rates it a 10/10. Breath sounds are present bilaterally. In this situation, the EMT should attribute the hypoxia to which one of the following?

A) The fractured ribs have pierced the lung, causing it to collapse.
B) Swelling from the rib fractures has compressed the lung.
C) The patient is bleeding into the lungs, compressing the alveoli.
D) Pain from rib injury prevents full expansion of the chest cage.

Question 19

Under normal circumstances, carbon dioxide is excreted from the body through the:

A) kidneys.
B) urinary tract.
C) lungs.
D) sweat ducts.

Question 20

What happens after a cell in anaerobic metabolism breaks down glucose and creates energy in the form of adenosine triphosphate (ATP)?

A) Oxygen and water are created.
B) Lactic acid is formed.
C) Carbon dioxide and water are formed.
D) Electrolytes in the cell become balanced.

Question 21

Which of the following statements about chemoreceptors in the human body is true?

A) The central chemoreceptors are located in the lungs and provide the primary stimulus to breathe.
B) The peripheral chemoreceptors are extremely sensitive to oxygen and are located in the brain.
C) The central chemoreceptors constantly monitor the oxygen levels in the body and increase the rate when more O₂ is needed.
D) The peripheral chemoreceptors are more sensitive to oxygen than carbon dioxide.

Question 22

An unresponsive patient is breathing at a rate of 6 breaths per minute. What intervention would be most beneficial for the patient?

A) Positive pressure ventilation with O₂ a rate of 30 and tidal volume of 200 mL
B) Oxygen at 15 liters per minute delivered through a nonrebreather face mask
C) Positive pressure ventilation with a rate of 12 and tidal volume of 500 mL
D) Oral airway and positive pressure ventilation at 40 per minute, supplemental O₂, and volume of 100

Question 23

A 100-kilogram patient with a 500-milliliter tidal volume breathing 16 times each minute would have a minute ventilation of how many milliliters?

A) 8,000
B) 1,200
C) 1,600
D) 2,400

Question 24

Which one of the following conditions would most likely account for an elevated carbon dioxide level in a patient's body?

A) Renal failure
B) Lung disease
C) Liver injury
D) Endocrine stem dysfunction

Question 25

Which of the following best describes the ventilation/perfusion ratio?

A) The ability of the red blood cells to offload oxygen to the cells of the body
B) The amount of blood and the pressure at which it carries oxygen throughout the body
C) The amount of air that is moved into and out of the lungs in 1 minute
D) The ability of the body to exchange gases across the alveolar capillary membrane

Question 26

Which of the following correctly identifies the primary way in which oxygen is transported to the cells?

A) Red blood cell
B) White blood cell
C) Plasma
D) Plasma proteins

Question 27

Assessment of a hypoxic patient with a history of lung disease reveals him to be using well-developed accessory muscles to exhale. As an EMT, you should recognize that the patient:

A) is inadequately exhaling oxygen from his lungs.
B) is using energy to exhale and is in danger of respiratory failure.
C) has a problem with the red blood cells in transporting oxygen.
D) is adequately compensating for the problem with his breathing.

Question 28

A patient who is weak informs you that she has a history of her "iron being too low." This should concern the EMT because iron is needed to:

A) make the white blood cells required for fighting infection.
B) help the blood to clot.
C) carry oxygen throughout the body.
D) maintain an adequate blood pressure in the body.

Question 29

Which one of the following conditions must be met for carbon dioxide to be moved from the cell to the bloodstream?

A) The blood must be low in carbon dioxide.
B) The sodium/potassium pump must be functional.
C) There must be a high amount of oxygen in the blood.
D) There must be a high number of red blood cells in the blood.

Question 30

Which one of the following is the primary stimulus to breathe in normal human beings?

A) Level of CO₂ in the body
B) Amount of oxygen required by the body
C) Level of oxygen in the body
D) Amount of nitrogen in air

Question 31

Which of the following statements would be true of a patient who relies on the hypoxic drive to breathe?

A) The primary gas affecting the respiratory rate is carbon dioxide.
B) The peripheral chemoreceptors have become less sensitive to oxygen.
C) The respiratory rate is set according to the level of O₂ in the body.
D) The central chemoreceptors are the primary influence on the respiratory rate.

Question 32

Which of the following statements about the ventilation/perfusion (V/Q) ratio in a healthy person is true?

A) Blood flow and amount of ventilation are equal throughout the lungs.
B) The upper portion of the lungs has more ventilation than blood flow.
C) Amount of blood is greater than amount of oxygen in the lungs.
D) The lower portion of the lungs has more oxygen than perfusion.

Question 33

Which of the following will affect the ventilation component of the ventilation/perfusion ratio?

A) Blood clot in the pulmonary blood vessels
B) Loss of blood plasma from dehydration
C) Infection and pus in the distal airways and alveoli
D) Decreased amount of hemoglobin in the blood

Question 34

Which one of the following conditions is most likely to cause acidosis?

A) Irregular heart rhythm
B) Hypothyroidism
C) Depressed respirations
D) Low blood glucose level

Question 35

A patient with a high fever has an accelerated metabolism and is producing abnormally high amounts of carbon dioxide at the cellular level. To compensate, which one of the following will occur?

A) Decreased levels of acid in the blood
B) Decreased respiratory rate
C) Decreased depth of breathing
D) Increased respiratory rate

Question 36

A patient with severe iron deficiency anemia is hypoxic. What is definitive care for this patient?

A) IV fluids by paramedics
B) Supplemental oxygen
C) Positive pressure ventilation
D) Blood transfusion

Question 37

A patient's SpO₂ increased from 89% to 95% after he received a bronchodilating drug for his asthma. Where did the patient's problem most likely originate?

A) Perfusion portion of the V/Q ratio
B) Minute volume of the V/Q ratio
C) Cellular perfusion portion of the V/Q ratio
D) Ventilation portion of the V/Q ratio

Question 38

Which one of the following best describes minute ventilation?

A) Number of breaths a patient breathes in one minute
B) Amount of air moved into and out of the lungs in one minute
C) Total milliliters of air moving into and out of the lungs in one breath
D) Amount of oxygen needed by the body in one minute

Question 39

For a patient reliant on the hypoxic drive to breathe, the respiratory rate will increase when:

A) carbon dioxide levels increase.
B) oxygen levels decrease.
C) CO₂ levels decrease and O₂ levels increase.
D) oxygen and CO₂ levels both increase.

Question 40

Which of the following medical conditions would impair a patient's respiratory status by directly damaging the central chemoreceptors?

A) Brainstem stroke
B) Lung cancer
C) Aerobic metabolism
D) Collapsed lung

Question 41

A patient has failure of the left side of his heart. Consequently, the blood is backing up into the pulmonary artery and spilling out into the lung tissue, causing him to be short of breath and moderately hypoxic. The EMT should recognize this condition as a product of:

A) increased hydrostatic pressure.
B) decreased circulating blood volume.
C) increased osmotic pressure.
D) decreased pulmonary perfusion.

Question 42

The body will compensate for a decrease in cardiac output by:

A) increasing systemic vascular resistance.
B) increasing the respiratory rate.
C) dilating to arteries, veins, and capillaries.
D) decreasing the heart rate.

Question 43

A slightly confused but conscious 61-year-old female with generalized weakness has a heart rate of 190 beats a minute. She has a history of high blood pressure and diabetes. Her blood pressure is 78/56 mmHg. Which one of the following would best explain the patient's presentation?

A) Hemorrhage
B) Hypoglycemia
C) Hypoxia
D) Tachycardia

Question 44

The best way to decrease a patient's afterload would be to:

A) slow the heart rate.
B) reduce the blood pressure.
C) administer intravenous fluids.
D) provide supplemental oxygen.

Question 45

Paramedics have administered a medication to a patient in heart failure. The medication specifically causes the veins to enlarge, thus decreasing the amount of blood coming back to the heart for pumping. The EMT would recognize this action as:

A) afterload.
B) pulse pressure.
C) preload.
D) systemic vascular resistance.

Question 46

A patient with a temperature of 105.4°F is suffering from systemic vasodilation. Which one of the following findings would be consistent with this condition?

A) Slow heart rate
B) Elevated afterload
C) Decreased blood pressure
D) Pale and cool skin

Question 47

Which one of the following would result from increasing a patient's preload?

A) Increased cardiac output
B) Increased oxygen delivery into the lungs
C) Decreased blood pressure
D) Decreased myocardial contraction

Question 48

In the hospital, a patient was administered an IV fluid with a high oncotic pressure. Once in the body, the EMT would expect which one of the following actions?

A) Fluid from the tissue to move into the bloodstream
B) Fluid to move evenly from the bloodstream into the cells
C) Fluid from the IV to move into the cells and rehydrate them
D) A dramatic decrease in the patient's blood pressure

Question 49

A chronically elevated afterload increases the patient's chance for developing which one of the following conditions?

A) Liver disease
B) Hypotension
C) Diabetes
D) Heart failure

Question 50

On scene, a 43-year-old male states that he has a history of liver failure and does not produce enough of the protein albumin. Given this condition, which one of the following would you expect?

A) Elevated temperature and signs of infection
B) Low SpO₂ reading from significant edema
C) Swelling of the extremities and abdomen
D) Decreased heart rate and signs of hypoxia

Question 51

A patient has a blood pressure of 140/98 mmHg. Which one of the following can the EMT ascertain from this reading?

A) The pulse pressure is narrowed.
B) The afterload is increased.
C) The preload is diminished.
D) The SpO₂ level must be abnormal.

Question 52

What is the protective mechanism underlying a narrowed pulse pressure?

A) Increase the amount of oxygen entering the lungs.
B) Stop the loss of blood internally or externally.
C) Increase the oxygen-carrying capacity of the red blood cells.
D) Maintain an adequate blood pressure for perfusion.

Question 53

The EMT would most likely see a narrowed pulse pressure in a patient who:

A) is bleeding internally.
B) has a fever.
C) suffers from diabetes.
D) has an irregular heartbeat.

Question 54

If a patient's blood pressure cannot be increased by adding volume, then which of the following actions would most likely be successful in increasing it?

A) Blocking beta actions of the sympathetic nervous system
B) Decreasing the patient's preload
C) Vasoconstriction
D) Decreasing the patient's afterload

Question 55

A patient with high blood pressure takes a medication to slow his heart rate, thus lowering his blood pressure. The EMT would recognize this action as impacting the:

A) preload.
B) afterload.
C) systemic vascular resistance.
D) cardiac output.

Question 56

Which one of the following measurements indicates a narrowed pulse pressure?

A) 120/76
B) 108/88
C) 210/138
D) 116/82

Question 57

Which one of the following would most likely cause a patient to have a simple episode of syncope (fainting)?

A) Increase in systemic vascular resistance
B) Parasympathetic stimulation
C) Activation of the sympathetic nervous system
D) Sudden release of norepinephrine

Question 58

When a healthy person has a sudden increase in blood pressure, which one of the following will occur?

A) Chemoreceptors will increase the rate and depth of breathing.
B) Baroreceptors will directly stimulate the parasympathetic nervous system.
C) The heart rate will increase and blood vessels will constrict.
D) Baroreceptors will signal the brain to decrease the heart rate.

Question 59

Which one of the following best describes the concept of afterload?

A) Pressure that the left ventricle must pump blood against
B) Ability of the heart to adequately contract and pump blood
C) Amount of blood that a person has in the arteries at any one given moment
D) Amount of blood returned to the lungs for oxygenation

Question 60

For the patient with a narrowed pulse pressure, which one of the following is occurring?

A) The heart rate is decreasing.
B) The veins and arteries are dilating.
C) The blood vessels are constricting.
D) The blood is being pumped more slowly.

Question 61

A patient with asthma is extremely short of breath and hypoxic. Related to the ventilation/perfusion ratio (V/Q), the EMT would recognize the problem lying in:
(A) inadequate oxygen in the alveoli.
(B) decreased cardiac output to circulate oxygen.
(C) inadequate oxygen in the ambient air.
(D) decreased blood volume to carry oxygen.

Question 62

A drop in blood pressure below a critical threshold is a threat to the body because it directly impairs:

A) anaerobic metabolism.
B) cellular perfusion.
C) airway patency.
D) the sympathetic nervous system.

Question 63

Baroreceptors function in the body by:

A) monitoring the heart rate.
B) ensuring adequate oxygenation of the red blood cells.
C) monitoring the blood pressure.
D) stimulating the production of red blood cells.

Question 64

A 35-year-old male is lethargic and dehydrated after working at a construction site for 12 hours on a very hot day. You obtain the following vital signs: pulse 136, respirations 22, blood pressure 102/88, and SpO₂ 100% with supplemental oxygen. As a knowledgeable EMT, you would recognize:
(A) widened pulse pressure to circulate more blood.
(B) elevated heart rate to increase cardiac output.
(C) rapid respirations to decrease CO₂ loss.
(D) low blood pressure to conserve the body's energy.

Question 65

A confused and lethargic 24-year-old male has intentionally overdosed on a narcotic medication. His vitals signs are: pulse 36, respirations 8, blood pressure 50/20, and SpO₂ 88% with 15 liters per minute of oxygen. The greatest danger to this patient's well-being is:
(A) decreased cellular perfusion.
(B) altered mental status.
(C) increased sympathetic nervous system stimulation.
(D) left ventricular heart failure.

Question 66

The EMT would recognize which of the following vital signs as most likely to cause left ventricular failure?
(A) Chronically elevated systolic blood pressure between 140 and 160 mmHg
(B) Chronically decreased diastolic blood pressure between 30 and 50 mmHg
(C) Chronically decreased systolic blood pressure between 60 and 80 mmHg
(D) Chronically elevated diastolic pressure between 120 and 140 mmHg

Question 67

A patient has been shot three times in the abdomen and has massive internal hemorrhage and blood loss. What will best give this patient a chance at survival?
(A) High-concentration oxygen
(B) Stopping the bleeding
(C) Positive pressure ventilation
(D) Paramedic intervention for pain management

Question 68

Which of the following would directly compromise the average patient's cardiac output?
(A) Heart rate of 170 beats per minute
(B) Circulatory volume of 5 liters
(C) Increased number of circulating WBCs
(D) Blood pressure of 118/52

Question 69

You are caring for a 66-year-old male who is severely dehydrated. Given this condition, you would recognize which of the following related to the cardiovascular system?
(A) Difficulty of the hemoglobin in carrying oxygen
(B) Decreased ability of oxygen to diffuse from the lungs to the blood
(C) Decreased production of white blood cells
(D) Decreased blood volume available for circulation

Question 70

A patient with liver disease suffers from a low platelet count. Which of the following would the EMT directly correlate to this condition?
(A) Pale skin color
(B) SpO₂ 90%
(C) Bruising to arms
(D) Heart rate 92

Question 71

A patient with a severe infection is very sick. Circulating toxins from bacteria in his blood have decreased his systemic vascular resistance (SVR). Which of the following would the EMT correlate to this condition?
(A) Blood pressure of 174/126 mmHg
(B) Diastolic blood pressure of >200 mmHg
(C) Blood pressure of 74/26 mmHg
(D) Systolic blood pressure of 160 mmHg

Question 72

For a patient who is bleeding, which of the following is the immediate response of the human body?
(A) Vasoconstriction caused by the parasympathetic nervous system
(B) Increased production of red blood cells and hemoglobin
(C) Vasoconstriction caused by the sympathetic nervous system
(D) Increased pulse pressure to promote better circulation of oxygen

Question 73

A patient with cancer is receiving chemotherapy. As a side effect of the treatment, her white blood cell count is critically low. Given this situation, which sign or symptom should the EMT find particularly concerning?
(A) History of diabetes
(B) Oral temperature 102.7ᵒF
(C) Complaint of weakness
(D) Blood pressure of 102/64

Question 74

You and the critical care transport team are taking a critically ill patient to another hospital. Among many IV infusions and monitors, the patient is also on a ventilator. You note that the FDO₂ is set at 0.50. What does this mean?
(A) Fifty percent of the patient's respirations are provided by the ventilator.
(B) Ventilations are provided when the patient breathes less than 50 times a minute.
(C) The patient is being ventilated at a rate pf 50 breaths per minute.
(D) The provided oxygen concentration is set at 50 percent.